Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Awards
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
    • Women in Healthcare
    • - Luminaries
    • - Top 25 Diversity Leaders
    • - Leaders to Watch
    • - Luminaries
    • - Top 25 Women Leaders
    • - Women to Watch
  • Events
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Leadership Symposium
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Diversity Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Strategic Marketing
    • - Virtual Health
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Post-Acute Care
January 25, 2022 09:12 AM

With vaccine mandate looming, nursing homes face more staffing issues

Eric Berger, Kaiser Health News
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    mh_20150810p14_nursing-home_i.jpg

    Jamie Smith, a staffing agency nurse who loves end-of-life care, said she has been warmly welcomed by staffers and residents at Frontier Health & Rehabilitation in this conservative St. Louis suburb.

    That's even though she has not been vaccinated against COVID-19.

    But leaders of the nursing home, where 22 residents died from COVID before vaccines were available, likely won't be able to employ unvaccinated people like Smith for much longer. The U.S. Supreme Court on Jan. 13 upheld a federal mandate requiring healthcare workers at facilities that receive Medicaid or Medicare funding to be fully vaccinated. If all staffers — excluding those with approved religious or medical exemptions — aren't fully vaccinated, the facility will lose that money.

    Read more: Supreme Court allows healthcare worker vaccine mandate to continue

    Healthcare sites in Missouri and other states that challenged the federal requirement have until March 15 for their staffs to be fully vaccinated, according to the Centers for Medicare & Medicaid Services, while facilities in states that didn't sue to block the mandate have a Feb. 28 deadline.

    That poses a challenge for Frontier and its residents because the nursing home already doesn't have enough staffers. And it is in the state with the lowest rate of fully vaccinated nursing home healthcare workers, 67% as of Jan. 9, according to CMS data. Frontier's reported staff vaccination rate was just 30% at the start of the year.

    That compares with a national rate of 81%, according to the federal data.

    Read more:
    CMS pushes deadline for vaccine mandate in 24 states
    CMS vaccine policy now enforceable in all 50 states

    Although the mandate ensures that unvaccinated staff members are not caring for some of the people most vulnerable to the virus, not enough workers are willing to take the low-paying, challenging jobs. If they quit to avoid getting shots or are fired because they won't get them, nursing home residents might not be any safer — because of lack of care.

    "Obviously we need good staff members to take care of residents, but the residents need to be safe as well," said Marjorie Moore, who supports the mandate and is executive director of Voyce, a St. Louis nonprofit that advocates for nursing home residents and their families.

    "A person who lives in their own home has the chance to say, 'I don't want somebody in my home who isn't vaccinated,'" she added. "In a nursing home, they don't have the opportunity to say, 'I don't want somebody who is unvaccinated coming up and feeding me.'"

    The problem of inadequate staffing at nursing homes predates the pandemic, and it's gotten worse.

    Not a Modern Healthcare subscriber? Sign up today.

    In March 2020, 3.3 million people were employed at U.S. nursing homes and residential care facilities, according to the Bureau of Labor Statistics. In December 2021, that number had dropped to 2.9 million, a loss of 400,000 workers.

    Nursing home operators can't find enough staffers because they often don't pay much. The mean hourly wage for nursing assistants in Missouri was $13.33 in 2020, according to the statistics bureau. And the homes require employees to take on a slew of responsibilities, including feeding residents, changing adult diapers, and caring for residents who have dementia and may become combative.

    Nursing assistants "can typically find a job with better pay that is less physically and emotionally demanding," said Brian McGarry, a University of Rochester professor who studies long-term care. "Somebody's life and dignity is in your hands, and it's a huge responsibility, and you are not getting paid commensurate with that responsibility."

    Those downsides of the job often lead to significant turnover. In 2017-18, the turnover rate among nursing home employees in Missouri was 138%, the fourth-highest in the country, according to a study in the journal Health Affairs. Frontier had a rate of more than 300%, according to Huizi Yu, one of the study's authors.

    The nursing home's management declined to comment.

    Smith, the nurse who works for a healthcare staffing agency, said she has not been vaccinated against COVID because she had a rare cancer in 2017 and is "very particular about what I put in my body."

    She said, "I'm not sure if I would be able to get it just to keep a job."

    But, she noted in a text message, "I still practice safely."

    And, indeed, no Frontier residents have died from COVID since the outbreak at the start of the pandemic, according to the federal data. But the center reported having seven new confirmed cases among its residents and 10 new cases among its staff as of Jan. 9. At the beginning of the year, 89% of residents were fully vaccinated against COVID.

    Low vaccination levels among staffers place residents at greater risk, according to a recent analysis in The New England Journal of Medicine. Facilities in high-COVID counties with an average staff vaccination rate of approximately 30% had nearly three times as many COVID deaths among residents as facilities where about 82% of employees were vaccinated, the analysis found.

    "An unvaccinated or low-vaccinated staff, I think, pretty clearly puts residents at risk — even if they are vaccinated," said McGarry, one of the analysis's authors.

    The vaccination rate has increased from fewer than half of Missouri nursing home staff members when President Joe Biden announced the mandate for nursing homes Aug. 18 to about two-thirds of staffers now, according to the federal data.

    Like Frontier, Northview Village does not have enough staffers, and most people who work there have not been vaccinated. The facility — a nursing home in a predominantly Black, low-income north St. Louis neighborhood — held a vaccination drive in December to increase its roughly 20% staff vaccination rate, but the numbers did not rise, according to the federal data. And only half of residents were fully vaccinated.

    The Northview management declined to comment.

    Kimberly Watkins, a technician who works to keep Northview residents active, was reluctant to get any of the shots, in part because she heard the conspiracy theory that they contained a tracking chip. But she said she decided to go ahead and get vaccinated because she has asthma and high blood pressure. Co-workers told her their doctors said that they didn't need the vaccine or that they may be allergic to it.

    Now with the mandate taking effect, Moore, of the nonprofit Voyce, thinks most local nursing home staffers will comply.

    She highlighted Mary, Queen and Mother Center, a Catholic nonprofit nursing home in St. Louis County, that announced its own mandate in August. Before its Sept. 30 deadline, the nursing home saw its staff vaccination rate increase from 67% to 92%, with the remainder being those with a medical or religious exemption, according to the organization. The facility retained almost all its staff.

    Not everyone is worried about nursing home staffers being vaccinated, in part reflecting the community around them. Just 55% of Missourians are fully vaccinated.

    "I'm not into forcing stuff on people," said Antuan Diltz, a St. Louis firefighter whose mother is a 64-year-old retired nurse with dementia and diabetes living at Frontier. She received the vaccine; Diltz had not.

    But others, like Bill Talton, who have family at Frontier hope more staffers will get the shots. Talton, a 77-year-old retired computer programmer, said he is happy with the care his younger brother, who has dementia, has received, although he sometimes couldn't visit him during COVID-related lockdowns.

    "It's kind of late in the game," said Talton, who is fully vaccinated and received a booster. "They'll get it done — I hope."

    Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

    Related Articles
    Families complain about COVID testing for nursing home visits
    COVID deaths and cases are rising again at U.S. nursing homes
    Missouri to let nursing homes close due to vaccine mandate
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    finance_arrows_cash_UP_i.png
    Gas prices, inflation stalling home health industry
    Nursing home COVID copy 2_i.png
    COVID-19's toll could spur a long-deferred transformation of nursing home care
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate/Eligibility
      • 100 Most Influential People
      • 50 Most Influential Clinical Executives
      • Best Places to Work in Healthcare
      • Excellence in Governance
      • Health Care Hall of Fame
      • Healthcare Marketing Impact Awards
      • Top 25 Emerging Leaders
      • Top 25 Innovators
      • Diversity in Healthcare
        • - Luminaries
        • - Top 25 Diversity Leaders
        • - Leaders to Watch
      • Women in Healthcare
        • - Luminaries
        • - Top 25 Women Leaders
        • - Women to Watch
    • Events
      • Conferences
        • Transformation Summit
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Leadership Symposium
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Diversity Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Strategic Marketing
        • - Virtual Health
      • Webinars
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing